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Topic Review
Vasospasm in Fluoropyrimidine-Induced Ischemic Heart Disease
Cardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, mechanisms, and manifestation remain poorly defined. Ischemia secondary to coronary artery vasospasm is thought to be the most frequent cardiotoxic effect of 5-FU. The available evidence of 5-FU-induced epicardial coronary artery spasm and coronary microvascular dysfunction suggests that endothelial dysfunction or primary vascular smooth muscle dysfunction (an endothelial-independent mechanism) are the possible contributing factors to this form of cardiotoxicity. In patients with 5-FU-related coronary artery vasospasm, termination of chemotherapy and administration of nitrates or calcium channel blockers may improve ischemic symptoms. However, there are variable results after administration of nitrates or calcium channel blockers in patients treated with 5-FU presumed to have myocardial ischemia, suggesting mechanisms other than impaired vasodilatory response. 
  • 838
  • 22 Apr 2022
Topic Review
Drug Coated Balloons Characteristics according to Antiproliferative Drugs
Drug coated balloons (DCBs) are indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a ‘leave nothing behind’ strategy could offer a reduction of the inflammatory stimulus and thrombotic risk.
  • 838
  • 12 Jun 2023
Topic Review
Ultrasound Assessment in Cardiogenic Shock Weaning
Cardiogenic shock (CS) is associated with a high in-hospital mortality despite the achieved advances in diagnosis and management. Invasive mechanical ventilation and circulatory support constitute the highest step in cardiogenic shock therapy. Once established, taking the decision of weaning from such support is challenging. Intensive care unit (ICU) bedside echocardiography pro- vides noninvasive, immediate, and low-cost monitoring of hemodynamic parameters such as cardiac output, filling pressure, structural disease, congestion status, and device functioning. Supplemented by an ultrasound of the lung and diaphragm, it is able to provide valuable information about signs suggesting a weaning failure. The aim of this article was to review the state of the art taking into account current evidence and knowledge on ICU bedside ultrasound for the evaluation of weaning from mechanical ventilation and circulatory support in cardiogenic shock.
  • 838
  • 03 Nov 2021
Topic Review
Cardiac Rehabilitation in COVID-19 Patients
Recent scientific literature has investigated the cardiovascular implications of COVID-19. The mechanisms of cardiovascular damage seem to involve the protein angiotensin-converting enzyme 2 (ACE2), to which severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) binds to penetrate cells and other mechanisms, most of which are still under study. Cardiovascular sequelae of COVID-19 include heart failure, cardiomyopathy, acute coronary syndrome, arrhythmias, and venous thromboembolism.
  • 837
  • 24 May 2021
Topic Review
Congenital Heart Defects in Newborns
Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach. 
  • 837
  • 28 Jun 2021
Topic Review
Epigenetic Modifications, Elderly Cardiovascular Disease
The rate of aging has increased globally during recent decades and has led to a rising burden of age-related diseases such as cardiovascular disease (CVD). At the molecular level, epigenetic modifications have been shown recently to alter gene expression during the life course and impair cellular function. In this regard, several CVD risk factors, such as lifestyle and environmental factors, have emerged as key factors in epigenetic modifications within the cardiovascular system.
  • 835
  • 30 Sep 2021
Topic Review
Heart Failure Pillar-Directed Medical Therapy
Heart failure with reduced ejection fraction (HFrEF) is a clinical condition associated with cardiac contractility impairment. HFrEF is a significant public health issue with a high morbidity and mortality burden. Pathological left ventricular (LV) remodeling and progressive dilatation are hallmarks of HFrEF pathogenesis, ultimately leading to adverse clinical outcomes. Therefore, cardiac remodeling attenuation has become a treatment goal and a standard of care over the last three decades. Guideline-directed medical therapy mainly targeting the sympathetic nervous system and the renin–angiotensin–aldosterone system (RAAS) has led to improved survival and a reduction in HF hospitalization in this population.
  • 835
  • 26 Oct 2021
Topic Review
Stroke Genomics
The pathophysiology of stroke involves many complex pathways and risk factors. Though there are several ongoing studies on stroke, treatment options are limited, and the prevalence of stroke is continuing to increase. Understanding the genomic variants and biological pathways associated with stroke could offer novel therapeutic alternatives in terms of drug targets and receptor modulations for newer treatment methods.
  • 835
  • 09 Mar 2022
Topic Review
Arrhythmogenic Cardiomyopathy
Arrhythmogenic cardiomyopathy (ACM) is a cardiomyopathy characterized by the occurrence of a high risk of life-threatening ventricular arrhythmias and sudden cardiac death even at presentation. 
  • 835
  • 13 May 2022
Topic Review
Lp(a) Paradox in Diabetes Mellitus
Lipoprotein(a) (Lp(a)) is one of the strongest causal risk factors of atherosclerotic disease. It is rich in cholesteryl ester and composed of apolipoprotein B and apo(a). Plasma Lp(a) levels are determined by apo(a) transcriptional activity driven by a direct repeat (DR) response element in the apo(a) promoter under the control of (HNF)4α Farnesoid-X receptor (FXR) ligands play a key role in the downregulation of APOA expression. In vitro studies on the catabolism of Lp(a) have revealed that Lp(a) binds to several specific lipoprotein receptors; however, their in vivo role remains elusive. In patients suffering from Type-I diabetes mellitus (T1DM), provided they are metabolically well-controlled, Lp(a) plasma concentrations are directly comparable to healthy individuals. In contrast, there exists a paradox in T2DM patients, as many of these patients have reduced Lp(a) levels; however, they are still at an increased cardiovascular risk. The Lp(a) lowering mechanism observed in T2DM patients is most probably caused by mutations in the mature-onset diabetes of the young (MODY) gene and possibly other polymorphisms in key transcription factors of the apolipoprotein (a) gene (APOA).
  • 834
  • 19 Jun 2022
Topic Review
Roles of MicroRNAs in Veterinary Cardiology
MicroRNAs are promising novel biomarkers for the diagnosis and prognosis of cardiovascular diseases. These molecules are defined as a class of short-sequence non-coding RNAs that influence the expression of numerous genes. Each miRNA is a short sequence of non-coding RNA that influences countless genes’ expression and, thereby, contributes to several physiological pathways and diseases. It has been demonstrated that miRNAs participate in the development of many cardiovascular diseases (CVDs). The growing understanding of cardiac biology contributed to recognising specific abnormal microRNA expression when diseases are present, which makes them potential biomarkers and therapeutical targets.
  • 834
  • 04 Nov 2022
Topic Review
Management of Dyslipidemia
Dyslipidemia, especially a circulating non-optimal level of cholesterol, is one of the most important risk factors for atherosclerotic cardiovascular disease (ASCVD), which accounts for the most deaths worldwide. Maintaining a healthy level of blood cholesterol is an important prevention strategy for ASCVD, through lifestyle intervention or cholesterol-lowering therapy. 
  • 834
  • 14 Nov 2022
Topic Review
3D Bioprinting in Cardiac Tissue Engineering
Cardiovascular diseases are the leading cause of morbidity and mortality in the United States. Cardiac tissue engineering is a direction in regenerative medicine that aims to repair various heart defects with the long-term goal of artificially rebuilding a full-scale organ that matches its native structure and function. Three-dimensional (3D) bioprinting offers promising applications through its layer-by-layer biomaterial deposition using different techniques and bio-inks. Recent advancements in this field have improved 3D bioprinting accuracy and resolution and its latest applications span cardiac tissues, patches, organoids, and the full organ. 
  • 834
  • 21 Jul 2023
Topic Review
Chronic Thoracic Aortic Dissection
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. 
  • 833
  • 31 Oct 2022
Topic Review
Insulin Receptors and Insulin Action in Heart
Heart failure is an early and severe complication of diabetes mellitus. The endocrine system and the heart are two interrelated entities, as this is proven by the close relationship between insulin and cardiac function. Insulin significantly contributes to cardioprotection via multiple pathways and various subsequent downstream proteins. Even slight malfunction in the participating pathways can lead to myocardial dysfunction, resulting finally in overt heart failure. At this stage, the implantation of an Left ventricular assist devices (LVADs) and its contribution to the regulation of the neuromodulatory effects of insulin on the heart is pivotal and may decelerate, stabilize, or even revert the deleterious cascades that have been activated in end-stage heart failure.
  • 832
  • 27 Apr 2022
Topic Review
Fatty Acids for Cardiovascular Disorders
Data are discussed regarding the roles of the most relevant fatty acids, such as myristic (C14:0), palmitic (C16:0), stearic (C18:0), palmitoleic (C16:1), oleic (C18:1), linoleic (C18:2), α-linolenic (C18:3, ω-3), γ-linolenic (C18:3, ω-6), arachidonic (C20:4), eicosapentaenoic (C20:5), docosahexaenoic (C22:6), and docosapentaenoic (C22:5) acid. The accumulated knowledge has expanded the understanding of the involvement of fatty acids in metabolic processes, thereby enabling the transition from basic exploratory studies to practical issues of application of these biomolecules to CVD treatment. In the future, these findings are expected to facilitate the interpretation and prognosis of changes in metabolic lipid aberrations in CVD.
  • 830
  • 31 Aug 2020
Topic Review
Dystrophin-Deficient Cardiomyopathy
Dystrophin-deficient cardiomyopathy (DDC) is currently the leading cause of death in patients with dystrophinopathies. Targeting myocardial fibrosis (MF) has become a major therapeutic goal in order to prevent the occurrence of DDC. 
  • 830
  • 18 Jan 2021
Topic Review
Renin-Angiotensin System Dysregulation as Severe COVID-19 Factor
Since the first months of the coronavirus disease 2019 (COVID-19) pandemic, several specific physiologic traits, such as male sex and older age, or health conditions, such as overweight/obesity, arterial hypertension, metabolic syndrome, and type 2 diabetes mellitus, have been found to be highly prevalent and associated with increased risk of adverse outcomes in hospitalized patients. All these cardiovascular morbidities are widespread in the population and often coexist, thus identifying a common patient phenotype, characterized by a hyper-activation of the “classic” renin-angiotensin system (RAS) and mediated by the binding of angiotensin II (Ang II) to the type 1-receptor. At the same time, the RAS imbalance was proved to be crucial in the genesis of lung injury after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, where angiotensin-converting-enzyme-2 (ACE2) is not only the receptor for SARS-CoV-2, but its down-regulation through internalization and shedding, caused by the virus binding, leads to a further dysregulation of RAS by reducing angiotensin 1-7 (Ang 1-7) production. 
  • 830
  • 23 Dec 2021
Topic Review
Angiotensin Receptor Blockers in Diabetic Neuropathy
Type 2 diabetes mellitus (T2DM) is becoming increasingly prevalent and currently affects approximately 14.3% of the adult US population. Moreover, a further 38.0% of the adult US population has prediabetes, i.e., impaired fasting glucose or impaired glucose tolerance. Diabetic neuropathy is a frequent complication of both T2DM and type 1 diabetes mellitus (T1DM), and it is present in approximately 3.5–9.4% of patients who havehad T1DM for 1–5 years and in 28% of patients who havehad T2DM for > 4 –7 years. Angiotensin receptor blockers (ARBs) are the antihypertensive agents of choice for hypertensive patients with diabetes mellitus (along with angiotensin-converting enzyme inhibitors, ACE-I). ARBs act by inhibiting the binding of angiotensin II (which is produced by the cleavage of angiotensin I by the angiotensin-converting enzyme) to angiotensin receptor I, thereby promoting vasodilation and inhibiting aldosterone secretion.
  • 830
  • 03 Aug 2022
Topic Review
Experimental Models of Takotsubo Syndrome
Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. 
  • 827
  • 17 Mar 2022
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